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Thursday, December 03, 2009

Andrew A. Nierenberg, MD - Failure to Integrate Brain and Mind

This is the kind of nonsense that we need to be working to counter in the psychology world. When flatlanders like this guy get to determine what is and is not a disorder, and when they rely on a medical model that does not see mind as unique, but as a by-product of brain function, our field is doomed to be owned by the pharmaceutical companies (as it nearly is already). Pay special attention to his drug company affiliations at the end of the op-ed.

And by the way, his reasoning his flawed. Seeing the mind and brain as the same thing is NOT the only option to Cartesian Dualism, it's just the only one his little mind can fathom.

First published in Psychiatry Weekly, Volume 4, Issue 27, on November 30, 2009.

René Descartes had difficulties with reason because of conflicts between it and his religion. How could transubstantiation exist, not as a metaphor, but as a real change in bread and wine during the Eucharist if the scientific method were also true? To solve his problem, Descartes protected faith by separating the physical (brain) and the mind and soul into different, but related realms. This separation (Cartesian Dualism) helped him maintain his belief in transubstantiation (which occurred in the nonmaterial realm) and his pursuit of Reason.

As many psychotherapists know, coping strategies at an earlier stage of life, if continued long after the original problem fades, can cause problems later in life. So, too, with Cartesian Dualism—René Descartes’ 17th century strategy to allow his belief in nonmaterial transubstantiation to exist alongside reason is causing problems for 21st century psychiatry.

If much of the population (including insurance companies and legislators) ascribe implicitly to Cartesian Dualism, then psychiatric disorders are not brain based, but are instead mind- or mentally-based, hence “mental illness.” If they are mentally-based, then the best explanation for those disorders is that people are responsible for their mental problems. If they are responsible for their problems, then why should we spend a lot of money treating and researching those problems? Medications will not heal sick souls.

Cartesian Dualism leads to unhelpful explanations of the causes of psychiatric disorders. Blame poor parenting (attention-deficit/hyperactivity disorder results from bad parenting); blame drug companies (children cannot have psychiatric disorders such as bipolar disorder because their minds are not yet developed, thus, if they are being treated with medications, it must be a conspiracy between doctors and drug companies); blame weakness (depression results if you cannot pull yourself up by your bootstraps); blame poor self-control (drug addicts could stop if they wanted to, how can this be brain based?). And so on.

Consider this hypothesis: Cartesian Dualism as the philosophical basis for explaining psychiatric diseases leads to inadequate funding for clinical care and research. Psychiatric departments frequently lose money for every patient that they treat, and NIMH funding is among the lowest of the institutes relative to the disorders’ costs. Why such problems?

One possible answer is that it is just too frightening for people to realize that all of our senses, knowledge, memories, emotions, thoughts, desires, actions, ability to reason and think and function, all depend on our physical brains, not on our souls or disembodied minds. We exist here and psychiatric disorders impact (and threaten) our very essence. Cartesian Dualism is false. Instead, our minds impact our brains and our brains impact our minds. The more knowledge about integrated mind/brains and brain/minds is disseminated, the less ignorance there is and the more treatment and research resources should follow.

Disclosure: Dr. Nierenberg consulted to or served on the advisory boards of Abbott, Appliance Computing, Inc., Brain Cells, Inc., Bristol-Myers Squibb, Eli Lilly, EpiQ, Forest, GlaxoSmithKline, Janssen, Jazz, Merck, Novartis, Pamlab, Pfizer, PGx Health, Pharmaceutica, Schering-Plough, Sepracor, Shire, Somerset, Takeda, and Targacept; he has received research support from Cederroth, Cyberonics, Forest, Medtronics, NARSAD, the NIMH, Ortho-McNeil-Janssen, Pamlab, Pfizer, Shire, and the Stanley Foundation through the Broad Institute; he has received past support from Bristol-Myers Squibb, Cederroth, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Pfizer, Lictwer Pharma, and Wyeth; he has received honoraria from the MGH Psychiatry Academy (MGHPA activities are supported through Independent Medical Education grants from AstraZeneca, Eli Lilly, and Janssen; he earns fees for editorial functions for CNS Spectrums through MBL Communications, Inc., and Psychiatric Annals through Slack, Inc.; he receives honoraria as a CME Executive Director for the Journal of Clinical Psychiatry through Physicians Postgraduate Press; he has been on the speaker’s bureaus of Bristol-Myers Squibb, Cyberonics, Eli Lilly, Forest, GlaxoSmithKline, and Wyeth; he has received royalties from Cambridge University Press and Belvoir Publishing; he owns stock options in Appliance Computing, Inc.; and owns the copyrights to the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale, exclusively licensed to the MGH Clinical Trials Network and Institute.